POST TRAUMATIC

STRESS DISORDER

PRESENTED BY
GARIMA NIRANKARI
M.PHIL CLINICAL PSYCHOLOGY (2022-2024)
 HISTORY
The term "post-traumatic stress disorder" came into
use in the 1970s in large part due to the diagnoses of
U.S. military veterans of the Vietnam War. It was
officially recognized by the American Psychiatric
Association in 1980 in the third edition of the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-III)
 INTRODUCTION
 Posttraumatic stress disorder and acute stress disorder are marked by
increased stress and anxiety following exposure to a traumatic or stressful
event.
 Traumatic or stressful events may include being involved in a violent
accident or crime, military combat, or assault, being kidnapped, being
involved in a natural disaster, being diagnosed with a life-threatening illness,
or experiencing systematic physical or sexual abuse.
 INTRODUCTION
The person reacts to the experience with fear and helplessness,
persistently relives the event, and tries to avoid being reminded of it.
 The event may be relived in dreams and waking thoughts (flashbacks)
The stressors causing both acute disorder and PTSD are sufficiently
overwhelming to affects almost everyone.
They are determined to avoid anything that brings the event to mind
and they undergo a numbing of responsiveness along with a state of
hyperarousal.
 EPIEMIOLOGY
Lifetime incidence - 9 to 15%
Lifetime prevalence - estimated to be about 8% of the general population,
lifetime prevalence rate is 10 percent in women and 4 percent in men.
According to the National Vietnam Veterans Readjustment Study
(NVVRS), 30 percent of men develop full-blown PTSD after having
served in the war .
Although PTSD can appear at any age, it is most prevalent in young
adults, because they tend to be more exposed to precipitating situations.
Children can also have the disorder.
 EPIDEMIOLOGY
Men and women differ in the types of traumas to which they are
exposed. Historically, men’s trauma was usually combat experience,
and women’s trauma was most commonly assault or rape.
The disorder is most likely to occur in those who are single,
divorced, widowed, socially withdrawn, or of low socioeconomic
level, but anyone can be effected, no one is immune.
A familial pattern seems to exist for this disorder, and First-degree
biological relatives of persons with a history of depression have
an increased risk for developing PTSD following a traumatic event.
 EPIDEMIOLOGY
 Prevalence rate of PTSD in India- 10.8% (Tan et al., 2020).

 Recent trends in the socio-demographic, Clinical Profile and

Psychiatric Comorbidity Associated with PTSD: A Study
From Kashmir, India- general population prevalence was
3.76%

 Lessons from the 2004 Asian tsunami- prevalence of PTSD

was 15.1%
 COMORBIDITY
 Comorbidity rates are high among patients with
PTSD, with about two thirds having at least two
other disorders. Common comorbid conditions
include depressive disorders, substance-related
disorders, anxiety disorders, and bipolar
disorders.
 ETIOLOGY
 Stressor is the prime causative factor in the development of
PTSD. Not everyone experiences the disorder after a traumatic
event, however. The stressor alone does not be sufficient to cause
the disorder. Clinicians must also consider individual’s
preexisting biological and psychosocial factors and events that
happened before and after the trauma. For example, a member of
a group who lived through a disaster can sometimes better deal
with trauma because others have also shared the experi ence.
 RISK FACTORS
Presence of childhood trauma
Borderline, paranoid, dependent or antisocial personality disorders trait
Inadequate family or peer support
Being female
Genetic vulnerability to psychiatric illness
Recently stressful life changes
Perception of an external locus of control (natural cause) rather than an internal
one (human cause)
Recent excessive alcohol intake
 CLINICAL FEATURES

AVOIDING
INCREASED
INTRUSION STIMULI
AUTOMATIC
SYMPTOMS ASSOCIATED WITH
AROUSAL
THE TRAUMA
 CLINICAL FEATURES
INTRUSION SYMPTOMS
Flashbacks, distressing recollections or dreams, physiological ( increased blood pressure
and heart rate, muscle tension, nausea, headaches and other types of pain) or psychological
stress reactions
AVOIDING STIMULI ASSOCIATED WITH THE TRAUMA
Include efforts to avoid thoughts or activities related to the trauma, anhedonia, reduced
capacity to remember events related to the trauma, blunted affect, feelings of detachment
or derealization, and a sense of a foreshortened future.
INCREASED AUTOMATIC AROUSAL
Increased arousal include insomnia, irritability, hyper vigilance, and exaggerated startle
 ICD-10 CRITERIA
Disorder should not generally be diagnosed unless there is evidence that it
arouse within 6months of a traumatic event of exceptional severity.
A “probable” diagnose might still be possible if the delay between the event
and the onset was longer than 6months provided that the clinical manifestations
are typical and no alternative identification of the disorder( e.g., anxiety, OCD,
or depressive episode) is plausible.
In addition to evidence of trauma there must be a repetitive, intrusive
recollection or reenactment of the event in memories, day-time imagery, or
dreams.
 ICD-10 CRITERIA (F43.10)
 Conspicuous emotional detachment, numbing of feeling, and avoidance of
stimuli that might arouse recollection of the trauma are often present but are not
essential for the diagnosis.
 The autonomic disturbances, mood disorder, and behavioral abnormalities all
contribute to the diagnosis but are not of prime importance.
 DSM 5 CRITERIA (309.81)
A. Exposure to actual or threatened death, serious injury, or sexual violence in
one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or
close friend. In cases of actual or threatened death of family member or friend,
the event(s) must have been violent or accidental.
 DSM 5 CRITERIA (309.81)
4. Experiencing repeated or extreme exposure to aversive details of the
traumatic event(s) (e.g., first responders collecting human remains; police
officers repeatedly exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure through electronic media,
television, movies, or pictures, unless this exposure is work related.
B. Presence of one (or more) of the following intrusion symptoms associated with
the traumatic event(s), beginning after the traumatic event(s) occurred:
 DSM 5 CRITERIA (309.81)
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic
event(s).
2. Recurrent distressing dreams in which the content and/or affect of the dream
are related to the traumatic event(s).
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts
as if the traumatic event(s) were recurring. (Such reactions may occur on a
continuum, with the most extreme expression being a complete loss of
awareness of present surroundings.)
 DSM 5 CRITERIA (309.81)
4. Intense or prolonged psychological distress at exposure to internal or external
cues that symbolize or resemble an aspect of the traumatic event(s).
5. Marked psychological reactions to internal or external cues that symbolize or
resemble an aspect of the traumatic event(s).
 DSM 5 CRITERIA (309.81)
C. Persistent avoidance of stimuli associated with the traumatic event(s),
beginning after the traumatic event(s) occurred, as evidenced by one or both of
the following:
1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings
about or closely associated with the traumatic event(s).
2. Avoidance of or efforts to avoid external reminders (people, places,
conversations, activities, objects, situations) that arouse distressing memories,
thoughts, or feelings about or closely associated with the traumatic event(s).
 DSM 5 CRITERIA (309.81)
D. Negative alterations in cognitions and mood associated with the traumatic
event(s), beginning or worsening after the traumatic event(s) occurred, as
evidenced by two (or more) of the following:
1. Inability to remember an important aspect of the traumatic event(s) (typically
due to dissociative amnesia and not to other factors such as head injury, alcohol,
or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself,
others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is
completely dangerous,” “My whole nervous system is permanently ruined”).
 DSM 5 CRITERIA (309.81)
D. Persistent, distorted cognitions about the cause or consequences of the
traumatic event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotion state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to
experience happiness, satisfaction, or loving feelings).
 DSM 5 CRITERIA (309.81)
D. Persistent, distorted cognitions about the cause or consequences of the
traumatic event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotion state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to
experience happiness, satisfaction, or loving feelings).
 DSM 5 CRITERIA (309.81)
E. Marked alterations in arousal and reactivity associated with the traumatic event(s),
beginning or worsening after the traumatic event(s) occurred, as evidence by two (or more)
of the following:
1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed
as verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behavior.
3. Hyper-vigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
 DSM 5 CRITERIA (309.81)
F. Duration of the disturbance (Criteria B, C, D, and E) is more
than 1 month.
G. The disturbance causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
H. The disturbance is not attributable to the physiological effects
of a substance (e.g., medication, alcohol) or another medical
condition.
 DSM 5 CRITERIA (309.81)
Specify whether:
With dissociative symptoms: The individual’s symptoms meet the criteria
for posttraumatic stress disorder, and in addition, in response to the
stressor, the individual experiences persistent or recurrent symptoms of
either of the following:
Depersonalization: Persistent or recurrent experiences of feeling detached
from, and as if one were an outside observer of, one’s mental processes
or body (e.g., feeling as though one were in a dream; feeling a sense of
unreality of self or body or of time moving slowly).
 DSM 5 CRITERIA (309.81)
Derealization: Persistent or recurrent experiences of unreality of surroundings
(e.g., the world around the individual is experienced as unreal, dreamlike,
distant, or distorted). Note: To use this subtype, the dissociative symptoms must
not be attributable to the physiological effects of a substance (e.g., blackouts,
behavior during alcohol intoxication) or another medical condition (e.g.,
complex partial seizures).
Specify whether:
With delayed expression: If the full diagnostic criteria are not met until at least 6
months after the event (although the onset and expression of some symptoms
may be immediate).
 DSM 5 CRITERIA FOR CHILDREN
6YEARS and YOUNGER (309.81)
A. Exposure to actual or threatened death, serious injury, or sexual violence in one
or more of the following ways : Directly experiencing the traumatic event(s).
1. Witnessing, in person, the event(s) as it occurred to others, especially primary
caregivers.
2. Learning that the traumatic event(s) occurred to a parent or caregiving figure.

B. Presence of one or more of the following intrusion symptoms associated with

the traumatic event(s), beginning after the traumatic event(s) occurred : Recurrent,
involuntary, and intrusive distressing memories of the traumatic event(s).
 DSM 5 CRITERIA FOR CHILDREN
6YEARS and YOUNGER (309.81)
1. Recurrent distressing dreams in which the content and/or effect of the dream
are related to the traumatic event(s).
2. Dissociative reactions (e.g., flashbacks) in which the child feels or acts as if the
traumatic event(s) were recurring. (Such reactions may occur on a continuum,
with the most extreme expression being a complete loss of awareness of present
surroundings.) Such trauma reenactment may occur in play.
3. Intense or prolonged psychological distress at exposure to internal or external
cues that symbolize or resemble an aspect of the traumatic event(s).
4. Marked psychological reactions to reminders of the traumatic event(s).
 DSM 5 CRITERIA FOR CHILDREN
6YEARS and YOUNGER (309.81)
C. One or more of the following symptoms, representing either persistent
avoidance of stimuli associated with the traumatic event(s), or negative
alterations in cognitions and mood associated with the traumatic event, must
be present, beginning after the traumatic event(s) or worsening after the event.
Persistent avoidance of stimuli
1. Avoidance of or efforts to avoid places or physical reminders that arouse
recollections of the traumatic event(s).
2. Avoidance of or efforts to avoid people, conversations, or interpersonal
situations that arouse recollections of the traumatic event(s).
 DSM 5 CRITERIA FOR CHILDREN
6YEARS and YOUNGER (309.81)
Negative alterations in cognitions
3.Substantially increased frequency of negative emotional
states (e.g., fear, guilt, sadness, shame, confusion).
4.Markedly diminished interest or participation in significant
activities, including constriction play
5.Social withdrawn behavior
6.Persistent reduction in expression of positive emotions.
 DSM 5 CRITERIA FOR CHILDREN
6YEARS and YOUNGER (309.81)
D. Alterations in arousal and reactivity associated with the traumatic event(s),
beginning or worsening after the traumatic event(s) occurred, as evidence by two (or
more) of the following:
1. Irritable behavior and angry outbursts (with little or no provocation) typically
expressed as verbal or physical aggression toward people or objects (including
extreme temper tantrums).
2.Hyper-vigilance.
3. Exaggerated startle response.
4.Problems with concentration.
5. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
 DSM 5 CRITERIA FOR CHILDREN
6YEARS and YOUNGER (309.81)
E. Duration of the disturbance is more than 1 month.
F. The disturbance causes clinically significant distress or impairment in relationships with
parents, sibling, peers, or other caregivers or with school behavior.
Specify whether:
With dissociative symptoms: The individual’s symptoms meet the criteria for post-
traumatic stress disorder, and in addition, in response to the stressor, the individual
experiences persistent or recurrent symptoms of either of the following:
Depersonalization: Persistent or recurrent experiences of feeling detached from, and as
if one were an outside observer of, one’s mental processes or body (e.g., feeling as though
one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
 DSM 5 CRITERIA FOR CHILDREN
6YEARS and YOUNGER (309.81)
Derealization: Persistent or recurrent experiences of unreality of
surroundings (e.g., the world around the individual is experienced as
unreal, dreamlike, distant, or distorted).
Specify if:
With delayed expression: If the full diagnostic criteria are not met
until at least 6 months after the event (although the onset and
expression of some symptoms may be immediate).
 ACUTE STRESS DISORDER
A. Exposure to actual or threatened death, serious injury, or sexual violation in one
(or more) of the following ways : Directly experiencing the traumatic event(s).
1.Witnessing, in person, the event(s) as it occurred to others.
2.Learning that the event(s) occurred to a close family member or close friend.
Note: In cases of actual or threatened death of a family member or friend, the
event(s) must have been violent or accidental.
3.Experiencing repeated or extreme exposure to aversive details of the traumatic
event(s) (e.g., first responders collecting human remains, police officers
repeatedly exposed to details of child abuse).
 ACUTE STRESS DISORDER
B. Presence of nine or more of the following symptoms from any of the five
categories of intrusion, negative mood, dissociation, avoidance, and arousal,
beginning or worsening after the traumatic event(s) occurred:
Intrusion Symptoms
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic
event(s). Note: In children, repetitive play may occur in which themes or aspects
of the traumatic event(s) occurred.
2. Recurrent distressing dreams in which the content and/or effect of the dream are
related to the event(s). Note: In children, there may be frightening dreams
without recognizable content.
 ACUTE STRESS DISORDER
3. Dissociative reactions (e.g., flashbacks) in which the individual feels
or acts as if the traumatic event(s) were recurring. (Such reactions may
occur on a continuum, with the most extreme expression being a
complete loss of awareness of present surroundings.)
Note: In children, trauma-specific reenactment may occur in play.
4. Intense or prolonged psychological distress or marked physiological
reactions in response to internal or external cues that symbolize or
resemble an aspect of the traumatic event(s).
 ACUTE STRESS DISORDER
Negative Mood
5. Persistent inability to experience positive emotions (e.g., inability to
experience happiness, satisfaction, or loving feelings).
Dissociative Symptoms
6. An altered sense of the reality of one’s surroundings or oneself (e.g.,
seeing oneself from another’s perspective, being in a daze, time slowing).
7. Inability to remember an important aspect of the traumatic event(s)
(typically due to dissociative amnesia and not to other factors such as head
injury, alcohol, or drugs).
 ACUTE STRESS DISORDER
Avoidance Symptoms
8. Efforts to avoid distressing memories, thoughts, or feelings about
or closely associated with the traumatic event(s).
9. Efforts to avoid external reminders (people, places, conversations,
activities, objects, situations) that arouse distressing memories,
thoughts, or feelings about or closely associated with the traumatic
event(s).
 ACUTE STRESS DISORDER
Arousal Symptoms
10. Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep).
11. Irritable behavior and angry outbursts (with little or no provocation),
typically expressed as verbal or physical aggression toward people or
objects.
12. Hyper-vigilance.
13. Problems with concentration.
14. Exaggerated startle response.
 ACUTE STRESS DISORDER
C. Duration of the disturbance (symptoms in Criterion B) is 3 days to 1
month after trauma exposure.
D. The disturbance causes clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a
substance (e.g., medication or alcohol) or another medical condition
(e.g., mild traumatic brain injury) and is not better explained by brief
psychotic disorder.
 DIFFERENTIAL DIAGNOSIS
Head Injury during the trauma.
Organic considerations - epilepsy, alcohol-use disorders, and other
substance-related disorders. Acute intoxication or withdrawal from some
substances may also present a clinical picture that is difficult to distinguish
from the disorder until the effects of the substance have worn off.
Panic Disorder and Generalized Anxiety Disorder- because all three
syndromes are associated with prominent anxiety and autonomic arousal.
PTSD is also associated with re-experiencing and avoidance of a trauma,
features typically not present in panic or generalized anxiety disorder.
 DIFFERENTIAL DIAGNOSIS
Major depression-it is important to note the presence of comorbid
depression, because this can influence treatment of PTSD.
Borderline Personality Disorder- Borderline personality disorder
can be difficult to distinguish from PTSD. The two disorders can
coexist or even be causally related.
Dissociative Disorders - patients with dissociative disorders do not
usually have the degree of avoidance behavior, the autonomic hyper-
arousal, or the history of trauma that patients with PTSD report.
 COURSE
PTSD usually develops some time after the trauma. The delay can be
as short as 1 week or as long as 30 years. Symptoms can fluctuate
over time and may be most intense during periods of stress.
Untreated, about 30 percent of patients recover completely, 40 percent
continue to have mild symptoms, 20 percent continue to have moderate
symptoms, and 10 percent remain unchanged or become worse. After 1
year, about 50 percent of patients will recover.
 PROGNOSIS
A good prognosis is predicted by
rapid onset of the symptoms,
short duration of the symptoms (less than 6 months),
good premorbid functioning
strong social support
the absence of other psychiatric, medical, or substance-related
disorders or other risk factors.
 PROGNOSIS
Young children- do not yet have adequate coping mechanisms to deal
with the physical and emotional insults of the trauma.
Older persons - more rigid coping mechanisms
The traumatic effects can be exacerbated by physical disabilities
characteristic of late life, particularly disabilities of the nervous system
and the cardiovascular system, such as reduced cerebral blood flow,
failing vision, palpitations, and arrhythmias.
Personality disorder- increases the effects of particular stressors
 Psychodynamic Factors
The psychoanalytic model of the PTSD hypothesizes that the trauma has
reactivated a previously quiescent, yet unresolved psychological conflict. The
revival of the childhood trauma results in regression and the use of the defense
mechanisms of repression, denial, reaction formation, and undoing.
According to Freud, a splitting of consciousness occurs in patients who reported
a history of childhood sexual trauma. A preexisting conflict might be
symbolically reawakened by the new traumatic event. The ego relives and
thereby tries to master and reduce the anxiety.
Persons who suffer from alexithymia, the inability to identify or verbalize
feeling states, are incapable of soothing themselves when under stress.
 Psychodynamic Factors
The psychoanalytic model of the PTSD hypothesizes that the trauma has
reactivated a previously quiescent, yet unresolved psychological conflict. The
revival of the childhood trauma results in regression and the use of the defense
mechanisms of repression, denial, reaction formation, and undoing.
According to Freud, a splitting of consciousness occurs in patients who reported
a history of childhood sexual trauma. A preexisting conflict might be
symbolically reawakened by the new traumatic event. The ego relives and
thereby tries to master and reduce the anxiety.
Persons who suffer from alexithymia, the inability to identify or verbalize
feeling states, are incapable of soothing themselves when under stress.
 Psychodynamic Factors
Psychodynamic themes in PTSD
The subjective meaning of a stressor may determine its traumatogenicity
Traumatic event can resonate with childhood traumas
Inability to regulate affect can result from trauma
Somatization and alexithymia may be among the after effects of trauma
Common defenses used include denial, minimization, splitting, dissociation and guilt
(as a defense against underlining helplessness)
Mode of object relatedness involves projection and introjection of the following
roles- omnipotent rescuer, abuser and victim.
 Cognitive-Behavioral Factors
The cognitive model of PTSD posits that affected persons cannot
process or rationalize the trauma that precipitated the disorder. They
continue to experience the stress and attempt to avoid experiencing it
by avoidance techniques. Consistent with their partial ability to cope
cognitively with the event, persons experience alternating periods of
acknowledging and blocking the event.
 Behavioral Model
Fear conditioning
Some patients with PTSD experience vivid memories of the traumatic
events in response to sensory cues, such as smells and sounds related
to the stressful situation. This finding suggests that classical
conditioning may be involved, as well as failure to extinguish
conditioned responses.
 BIOLOGICAL FACTORS
Noradrenergic System- Soldiers with PTSD-like symptoms exhibit
nervousness, increased blood pressure and heart rate, palpitations, sweating,
flushing, and tremors—symptoms associated with adrenergic drugs.
Studies found increased epinephrine concentrations in veterans with PTSD
and increased catecholamine concentrations in sexually abused girls.
Opioid System- Abnormality in the opioid system is suggested by low
plasma β-endorphin concentrations in PTSD. One study showed that
nalmefene (Revex), an opioid receptor antagonist, was of use in reducing
symptoms of PTSD in combat veterans.
BIOLOGICAL FACTORS
 BIOLOGICAL FACTORS
Brain imaging-
Smaller volume of the hippocampus (which may be a vulnerability
factor), over-activity of the amygdala in response to traumatic
psychological stimuli, as well as decreased activity in anterior
cingulate cortex and prefrontal cortex.
 TREATMENT
Major approaches are support, encouragement to discuss the event, and
education about a variety of coping mechanisms (e.g., relaxation).
To press a person who is reluctant to talk about a trauma into doing so
is likely to increase rather than decrease the risk of developing PTSD.
The use of sedatives and hypnotics can also be helpful in some cases.
Psycho-education should be provided.
Additional support for the patient and the family can be obtained
through local and national support groups for patients with PTSD.
 ONLINE SUPPORT GROUPS
Daily strength
After silence- for survivors of rape, sexual abuse, and sexual assault
Safe support group- for Complex PTSD
r/PTSD- for those who are seeking larger peer community
MyPTSD- for survivors and their loved ones
 PHARMACOTHERAPY
Selective Serotonin Reuptake Inhibitors (SSRIs), such as sertraline (Zoloft) and
paroxetine (Paxil), are considered first-line treatments for PTSD, owing to their
efficacy, tolerability, and safety ratings. Buspirone (BuSpar) is serotonergic and may
also be of use.
The efficacy of imipramine (Tofranil) and amitriptyline (Elavil), two tricyclic drugs,
in the treatment of PTSD is supported by a number of well-controlled clinical trials.
Patients who respond well should probably continue the pharmacotherapy for at least 1
year before an attempt is made to withdraw the drug.
Some studies indicate that pharmacotherapy is more effective in treating the
depression, anxiety, and hyperarousal than in treating the avoidance, denial, and
emotional numbing.
 PHARMACOTHERAPY
Monoamine oxidase inhibitors (MAOIs) (e.g., phenelzine [Nardil]),
trazodone (Desyrel), and the anticonvulsants (e.g., carbamazepine
[Tegretol], valproate [Depakene]).
Antiadrenergic agents, is suggested by the theories about noradrenergic
hyperactivity in the disorder.
Haloperidol (Haldol) should be reserved for the short-term control of
severe aggression and agitation.
Research is ongoing about the use of opioid receptor agonists during
traumatic events as a preventative against developing PTSD.
 PSYCHOTHERAPY
Psychological treatments such as trauma- focused cognitive behaviour
therapy and eye movement desensitization and reprocessing are more
effective than less specific treatments such as stress management,
supportive therapy, and hypnotherapy (Ehlers, 2009). It should be
noted that the majority of studies for treating PTSD have been
conducted following ‘single- episode’ events and that those exposed to
multiple traumatic events, such as those fleeing humanitarian disasters,
conflict, and prolonged sexual abuse might need different treatments.
 PSYCHOTHERAPY
Patients should be encouraged to sleep, using medication if necessary.
Support from persons in their environment (e.g., friends and relatives)
should be provided.
Patients should be encouraged to review and abreact emotional feelings
associated with the traumatic event and to plan for future recovery.
The amobarbital (Amytal) interview has been used to facilitate this process.
Psychotherapy after a traumatic event should follow a model of crisis
intervention with support, education, and the development of coping
mechanisms and acceptance of the event.
 PSYCHOTHERAPY
When PTSD has developed, two major psychotherapeutic approaches can be
taken.
The first is exposure therapy, in which the patient re-experiences the traumatic
event through imaging techniques or in vivo exposure. The exposures can be
intense, as in implosive therapy, or graded, as in systematic desensitization.
The second approach is to teach the patient methods of stress management,
including relaxation techniques and cognitive approaches, to coping with stress.
Some preliminary data indicate that, although stress management techniques are
effective more rapidly than exposure techniques, the results of exposure
techniques last longer.
 PSYCHOTHERAPY
Eye Movement Desensitization And Reprocessing (EMDR)- the
patient focuses on the lateral movement of the clinician’s finger while
maintaining a mental image of the trauma experience. The general
belief is that symptoms can be relieved as patients work through the
traumatic event while in a state of deep relaxation. Proponents of this
treatment state it is as effective, and possibly more effective, than
other treatments for PTSD and that it is preferred by both clinicians
and patients who have tried it.
 PSYCHOTHERAPY
Psychodynamic psychotherapy -In some cases, reconstruction of the
traumatic events with associated abreaction and catharsis may be
therapeutic, but psychotherapy must be individualized because re-
experiencing the trauma overwhelms some patients.
Time-limited psychotherapy- Therapy usually takes a cognitive approach
and also provides support and security. The short-term nature of
psychotherapy minimizes the risk of dependence and chronicity, but issues
of suspicion, paranoia, and trust often adversely affect compliance.
Therapists should overcome patients’ denial of the traumatic event, encoura
 PSYCHOTHERAPY
The advantages of group therapy include sharing of traumatic
experiences and support from other group members.
Family therapy often helps sustain a marriage through periods of
exacerbated symptoms.
Hospitalization may be necessary when symptoms are particularly
severe or when a risk of suicide or other violence exists.
THANK YOU